Under a new health accountability framework endorsed by the 81st UN General Assembly (UNGA) last month in New York, African governments have committed to subjecting their progress on maternal and child survival to annual continental scrutiny, reports The Voice of Africa.
South Africa was one of the 44 African Union Member States which backed the high-level communiqué on ending preventable maternal, newborn and child deaths, and boosting domestic health financing; strengthening primary healthcare, and reporting annually to the African Union on progress towards three targets known as the Three Zeros.
Those are zero home deliveries without skilled care and referral, zero preventable maternal and newborn deaths, and zero unvaccinated children.
African leaders will also hold a biennial Heads of State review to assess progress, identify weaknesses and determine what additional action is required.
After the high-level meeting held on the margins of UNGA 81 held in New York in September, Africa CDC published the final communiqué providing detailed commitments and an accountability framework for governments – the agreement representing an attempt to move beyond repeated political promises towards measurable results.
Women’s health
The continent accounts for nearly 70% of maternal deaths worldwide, 62% of all deaths among children under five, almost half of global stillbirths, and more than half of the world’s children who have received no routine vaccine doses.
However, WHO Director-General Dr Tedros Adhanom Ghebreyesus told the UNGA meeting that maternal mortality across the continent has fallen by about 40% over the past 25 years, while mortality among children under five has declined by more than half.
But most AU Member States remain off track to meet the 2030 Sustainable Development Goal targets for maternal and child mortality, with the new agreement concluding that Africa does not necessarily lack knowledge of how to prevent maternal and child deaths, but rather, it struggles to deliver known interventions consistently, equitably and at sufficient scale.
A woman may know she needs skilled care during childbirth – but she lives too far from a functioning health facility. A clinic may exist, but lack blood, medicines or trained personnel. A child may be eligible for vaccination but remain beyond the reach of routine immunisation services, while an emergency referral system may exist on paper but fail when transport is unavailable.
Preventable mortality therefore becomes a test of the entire health system, and the communiqué directly addresses one of the most difficult questions confronting African health systems: financing.
Governments committed to progressively increasing and sustaining domestic financing for reproductive, maternal, newborn, child and adolescent health while improving budget prioritisation, execution and accountability. Yet the commitment comes at a difficult time.
Many of them continue to depend heavily on international development assistance for some programmes, while donor financing is becoming less predictable and governments face high debt costs and limited fiscal space.
The proposed response is not the immediate elimination of external support. Instead, governments want international partners to align resources with country-owned health plans while African states gradually strengthen domestic financing and national control over health priorities.
Annual reports to AU
Governments committed to report annually to the AU Assembly on national progress towards the Three Zeros, using a Continental RMNCAH Scorecard and Dashboard to monitor financing, health-service readiness and results. Heads of State will then convene every two years for a review chaired by the African Union Champion for Maternal and Child Health – Tanzanian President Samia Suluhu Hassan, who was appointed to this position in February 2026.
Her role places maternal and child survival at presidential level rather than treating it solely as a technical matter for health ministries.
If implemented transparently, the reporting framework could make it easier to compare political promises with measurable outcomes and identify where governments are falling behind.
Governments also agreed that primary healthcare should become the principal platform through which maternal and child health services are delivered, including community health systems, referral networks and emergency care.
Local manufacturing becomes part of maternal survival
The agreement also connects maternal and child health with Africa’s wider effort to manufacture more health products locally. Partners are being asked to strengthen access to African-manufactured reproductive, maternal, newborn, child and adolescent health products.
The communiqué identified mechanisms including the African Pooled Procurement Mechanism, the Platform for Harmonised African Health Products Manufacturing, the African Medicines Agency and the Africa Vaccine Manufacturing Accelerator as potential tools for supporting that objective.
Local manufacturing is often discussed in relation to pandemics and vaccines, but routine maternal and child healthcare also depends on reliable supplies of medicines, diagnostics and medical equipment. A health system cannot consistently provide quality care when essential products repeatedly disappear from clinic shelves.
The communiqué does not place responsibility solely on African governments. The WHO, UNFPA (United Nations Population Fund), Unicef, Gavi, the Global Fund and other development and philanthropic partners were represented at the meeting, while African governments called for more predictable, flexible and long-term international support.
They also want partners to reduce fragmented programmes and align external financing with national health systems. A country can receive substantial international health funding while operating multiple programmes with different reporting systems, priorities and funding cycles, creating administrative burdens and weakening national planning.
The new framework therefore asks international partners to support country-owned systems rather than create parallel structures wherever possible.
Women will ultimately judge whether health sovereignty is working
The language of health sovereignty can appear distant from the everyday experience of healthcare, but maternal survival makes the concept concrete. A health system is not sovereign simply because its government writes its own strategy. It also needs the workforce, financing, medicines, infrastructure and institutions required to provide care when citizens need it.
For a pregnant woman experiencing severe bleeding, health sovereignty can mean whether a trained professional is available, whether blood can be obtained and whether emergency care can be reached in time. For a newborn, it can mean whether complications are recognised quickly. For a child, it can mean whether routine vaccines actually reach the community.
Africa CDC’s framework therefore links health sovereignty directly to whether African women, newborns, children and adolescents can reliably receive timely and quality care.
The next test is implementation
Africa has adopted many health declarations, so the importance of this agreement will ultimately depend on implementation.
Governments have committed to increase domestic financing, investigate preventable deaths, use common performance data, report annually to the African Union and subject progress to periodic review by Heads of State.
Those mechanisms could make the Three Zeros more than another continental aspiration, but only if the data are transparent, reviews are rigorous and political leaders respond when countries fall behind.
The final measure will be simpler. Africa’s progress will not ultimately be determined in conference rooms in New York or Addis Ababa. It will be determined in maternity wards, clinics and communities across the continent by whether African women survive childbirth, newborn babies receive the care they need, and children can receive life-saving vaccines regardless of where they are born.
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